Expected surgical competencies of an Indian medical graduate: a gap analysis using a cross-sectional survey.

BACKGROUND: In 2010, the Medical Council of India published the Vision 2015 document, which sought to create an 'Indian Medical Graduate' as a 'physician of first contact of the community while being globally relevant'. This vision for undergraduate medical education is proposed to be realised through a competency-based curriculum. We conducted a gap analysis using a cross-sectional survey to document surgeons' perceptions regarding competencies identified in surgery. METHODS: Eight competencies specific to surgery are proposed, which formed the basis for the study. We defined sub-competencies for each of these and developed a questionnaire containing ratings of importance and ability for the sub-competencies from low to very high on a 4-point Likert scale. The questionnaire was administered to 450 surgeons attending a state-level annual conference in surgery asking them to provide the importance ratings and their own ability on those (sub) competencies when they graduated. The importance and ability ratings were ranked and a gap analysis was done. RESULTS: The study response rate was 69.8%. While most competencies were perceived by the surgeons as being highly important, their self-ratings revealed a statistically significant gap between importance and ability when they graduated. They also rated themselves as being more competent on some than on others. Some competencies were high on importance as well as on ability, while others were high on importance but low on ability, revealing a gap. A low importance-high ability relationship was seen for a few competencies. Competencies related to emergency and trauma care and communication had the largest gaps. DISCUSSION: The gaps identified in surgical competencies for graduating physicians are specific and have implications for the competency-based curriculum and implementation in terms of teaching, assessment and faculty development. It also has implications for seamless transition between undergraduate and postgraduate competencies, as all of these are prerequisites at the start of a surgical residency.

Online faculty development for medical educators: experience of a South Asian program.

CONTEXT: India has the highest number of medical schools in the world. Teacher shortages and inadequate training of existing faculty are a major problem. On-line faculty development and learning is a plausible component of developing medical teachers in the essentials of pedagogy. METHODS: An on-line faculty development learning process utilized by Regional Institute Fellows of the Foundation for Advancement of International Medical Education and Research (FAIMER) is described. This faculty development program begins with a face-to-face meeting followed by an 11-month intersession on-line experience, then another face-to-face meeting and a second 11-month intersession on-line experience. During each on-line session, Fellows participate in discussions on topics which they identify based on their learning needs. The on-line program is highly interactive and Fellows and faculty serve as moderators. Discussions have a conversational tone and a semi-structured format which Fellows develop along with the faculty moderator. The participants share their personal and professional experiences and the moderator 'wraps up' with a summary of the learning posted at the end of the month. Faculty facilitate the discussion, sharing appropriate resources and clarifying issues when necessary. CONCLUSIONS: More than the content exchanged, the interpersonal learning environment facilitated effective learning, and rejuvenated the learning experiences and network established during the face-to-face sessions. In view of its cost-effectiveness and the flexible choices it offers, focused, moderated, interactive on-line faculty development and learning needs to be considered seriously as a medium offering opportunities to medical educators and other professionals.

Residency Evaluation and Adherence Design Study III: Ophthalmology residency training in India: Then and now-Improving with time?

Purpose: To gauge the differences in ophthalmology residency training, academic, clinical and surgical, in the last three decades of the 20th century and the first decade of the 21st century. Methods: A survey was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2014-2016, using a prevalidated questionnaire, which was circulated to ophthalmologists to gauge the practicality of the teaching protocols of clinical and surgical skills during postgraduate residency program. Results: Of the 1005 respondents, 320 ophthalmologists who completed residency between 1967 and 2002 (20th century trained) and 531 who completed a residency in 2003-2012 (21st century trained) fulfilled the inclusion criteria. The average age was 49.2 years (standard deviation [SD] 4) and 32.6 years (SD 4), respectively. Twenty-first century trained ophthalmologists rated their training significantly better than the 20th century trained ophthalmologists for slit lamp examination (P = 0.001), indirect ophthalmoscopy, gonioscopy, automated perimetry, optical coherence tomography, and fundus photography (all having P < 0.001), while the 20th century trained rated their teaching of refraction, synoptophore, diplopia charting better (all P < 0.001). The range of grading was 0-10 in all categories. The median number of surgeries performed independently by 20th century and 21st century trained (during their training period) were: intracapsular cataract extraction (ICCE) 10, 0; extracapsular cataract extraction (ECCE) 43, 18; small incision cataract surgery (SICS) 5, 55; phacoemulsification (Phaco) 0, 1; pterygium excision 20, 15; dacryocystectomy 11, 4; dacryocystorhinostomy 11, 2; chalazion 35, 30; trabeculectomies 5, 0; strabismus correction 0, 0; vitrectomy 0, 0; keratoplasty 0, 0; eyelid surgery 6, 2; and ocular emergencies 18, 20. Conclusion: Teaching of many clinical skills had improved over decades. Cataract surgery training has shifted from ICCE and ECCE to SICS and Phaco, but other surgeries were still taught sparingly. There was an enormous variation across the country in residency training which needs immediate attention.

From a "generalist" medical graduate to a "specialty" resident: can an entry-level assessment facilitate the transition? assessing the preparedness level of new surgical trainees.

INTRODUCTION: Concerns have been raised in the literature about how well the undergraduate curriculum prepares medical students for residency. An assessment was designed and administered to entering postgraduate residents in surgery to test their preparedness vis-a-vis the competence level expected of them at the beginning of their training. This paper explores the role and place of such an assessment in the medical education continuum. MATERIALS AND METHODS: Faculty members from the Department of Surgery at Bharati Vidyapeeth University Medical College (BVUMC), Pune, India and experts from the Department of Medical Education, University of Michigan Medical School, Ann Arbor designed and administered an assessment based on the multiple-choice question examination (MCQE) and objective structured clinical examination (OSCE) in June 2005 to 24 examinees from 3 different training levels at BVUMC. RESULTS: All subsections of the MCQE showed significant correlation except the breast and endocrine section. The test showed an overall reliability of 0.8 (Cronbach's alpha). The scores and level of difficulty of the OSCE were inversely related. There was a significant difference in performance between the 3 groups and these differences were more pronounced for more complex tasks, specifically the procedural skills station, where the intern performance was particularly poor. Clinical skills reliability was 0.85. The communication skills score correlated well with the clinical skills score and also showed good reliability. Four out of the 5 new residents had below-satisfactory levels of competence for this level. CONCLUSION: This pilot study reveals definite educational gaps in both knowledge and skills among the residents studied. Such an intervention can be very informative, providing immense educational benefit to the learner, faculty and programme, and has an important place in the continuum of medical training.

Training of medical teachers in India: need for change.

India has the highest number of medical colleges in the world and consequently the highest number of medical teachers. The unprecedented growth of medical institutions in India in the past two decades has led to a shortage of teachers and created a quality challenge for medical education. In recent years, though medical advances have been understood and adopted by many institutions, the same is not true for educational planning and implementation. There is a need for well-trained faculty who will help improve programs to produce quality graduates. The existing teachers' training programs are insufficient, both in number and the aspects that they cover, to meet this demand. The globalization of education and India's potential as a destination for higher education have brought the issue into sharper focus. Medical educators must stand up to meet this challenge. This paper briefly describes the current status of training programs for medical teachers in India, outlines an approach for developing future programs and defines key content areas to focus on in order to enhance faculty development efforts.

Heterosis as investigated in terms of polyploidy and genetic diversity using designed Brassica juncea amphiploid and its progenitor diploid species.

Fixed heterosis resulting from favorable interactions between the genes on their homoeologous genomes in an allopolyploid is considered analogous to classical heterosis accruing from interactions between homologous chromosomes in heterozygous plants of a diploid species. It has been hypothesized that fixed heterosis may be one of the causes of low classical heterosis in allopolyploids. We used Indian mustard (Brassica juncea, 2n = 36; AABB) as a model system to analyze this hypothesis due to ease of its resynthesis from its diploid progenitors, B. rapa (2n = 20; AA) and B. nigra (2n = 16; BB). Both forms of heterosis were investigated in terms of ploidy level, gene action and genetic diversity. To facilitate this, eleven B. juncea genotypes were resynthesized by hybridizing ten near inbred lines of B. rapa and nine of B. nigra. Three half diallel combinations involving resynthesized B. juncea (11×11) and the corresponding progenitor genotypes of B. rapa (10×10) and B. nigra (9×9) were evaluated. Genetic diversity was estimated based on DNA polymorphism generated by SSR primers. Heterosis and genetic diversity in parental diploid species appeared not to predict heterosis and genetic diversity at alloploid level. There was also no association between combining ability, genetic diversity and heterosis across ploidy. Though a large proportion (0.47) of combinations showed positive values, the average fixed heterosis was low for seed yield but high for biomass yield. The genetic diversity was a significant contributor to fixed heterosis for biomass yield, due possibly to adaptive advantage it may confer on de novo alloploids during evolution. Good general/specific combiners at diploid level did not necessarily produce good general/specific combiners at amphiploid level. It was also concluded that polyploidy impacts classical heterosis indirectly due to the negative association between fixed heterosis and classical heterosis.

Intramedullary spinal cysticercosis cured with medical therapy: case report and review of literature.

BACKGROUND: Spinal intramedullary cysticercosis is a very uncommon manifestation of NCC, which is caused by the larvae of Taenia solium. CASE DESCRIPTION: We report a case of spinal intramedullary cysticercosis who presented subacutely. Magnetic resonance imaging dorsal spine and CSF ELISA clinched the diagnosis. Eight weeks of medical therapy resulted in complete clinicoradiological cure. CONCLUSION: Surgery used to be the mainstay treatment for spinal intramedullary cysticercosis; however, early diagnosis and medical therapy with albendazole and dexamethasone can obviate the need for surgery in many patients.